Dealing with human factors and managing change in knowledge management: a phased approach.

Ten human factors affect the implementation of knowledge management initiatives, including fear, cultural change, capturing of tacit knowledge, ease of use, stakeholder involvement, and benefits realization. To deal with these factors, a phased change management approach is offered, consisting of an assessment, strategic planning, organization development, systems design, orientation and training, team building, and continuous evaluation and improvement.

Preparing health care professionals for quality improvement: the George Washington University/George Mason University experience.

Seventy-seven medical, physician assistant, nurse practitioner, and health services management students were provided training in quality improvement, community-oriented primary care, and teamwork. These students were then formed into 13 interdisciplinary teams to apply their knowledge in underserved areas ("service learning") under a community and faculty preceptor.

Strategic positioning: a case study in governance and management.

This case describes the experience of the Detroit Medical Center (DMC) in restructuring its governance and management. It provides a background on the DMC, examines the driving forces that led to modification of its structure, identifies key principles in guiding the change, and describes the strategies and specific steps taken in managing structural change. Finally, the critical lessons learned about leadership style, communication, agenda development, and relations with the board, medical staff, and management are discussed. This case study will help reduce the learning curve for any large, complex organization undertaking board and management restructuring to better meet its mission. At the time of DMC's restructuring there were no models to guide the effort. This case study attempts to reduce the gap in research on the management of structural change.

Blessed are the flexible: the George Team.

Our educational efforts produced several intersecting interdisciplinary groups: faculty, students, faculty/students and our community sites, with faculty, clinical staff, and students. As we worked through the issues, these interdisciplinary teams found that commitment to change, caring for patients, and open, honest communication were essential to keeping the project teams on track. We have increased our understanding of both the complexity and value of interdisciplinary collaborative education. The LIT faculty provided the initial guidance and support, the students energized the process, and our community sites made our learning and our contributions readily available to our patient populations. It is not easy to learn and teach the language and tools of continuous improvement, but doing so infinitely improves the educational process and the clinical outcome. We must learn to carefully listen to each other so that our patients can fully reap the benefits of our interdisciplinary team efforts. As a result of what we learned, the members of the George Team have expanded our motto to "Blessed Are the Flexible--and the Perseverant!"

Microflora and acarofauna of bed dust from homes in Upper Silesia, Poland.

BACKGROUND: Pyroglyphid mites are considered a major cause of house dust allergy. The occurrence and possible pathogenic role of other biologic components of house dust, in particular bacteria, has received less attention. OBJECTIVE: The aim of this study was to examine bacteria present in the samples of house dust from beds, in comparison to fungi and mites recovery. METHODS: Samples of bed dust were collected from 40 homes in Upper Silesia (Poland). Of these, 19 came from the homes of people with asthma caused by house dust and 21 from the homes of people without allergy. The concentrations of bacteria, fungi, mites, and endotoxin and species composition of microflora and acarofauna were determined. RESULTS: The overall mean concentrations of mesophilic bacteria, thermophilic bacteria and fungi, including yeasts, were, respectively, 1.6 x 10(6), 1.7 x 10(3), and 1.6 x 10(4) CFU/g. Samples contained an average of 8.4 mites/g and the ten samples assayed for bacterial endotoxin averaged 80.4 ng/mg. A total of 55 species of bacteria, 40 of fungi and 13 of mites were found. Gram-positive cocci (mostly Staphylococcus spp.) were the predominant mesophilic bacteria, followed by corynebacteria and Bacillus spp. Thermophilic bacteria were represented only by actinomycetes, with Thermoactinomyces vulgaris predominant. The most numerous fungi were Penicillium spp. and Aspergillus spp. followed by yeasts. The most abundant mites were Dermatophagoides spp. which formed > 85% of the total count. There were no significant differences between the homes of allergic and nonallergic people in the concentrations of total bacteria, fungi, and mites. Bacillus, Aspergillus and total filamentous fungi (molds), but not yeasts, were significantly more numerous in the homes of people with asthma caused by house dust. CONCLUSION: The results suggest that some species of bacteria and filamentous fungi should be considered potential causes of house dust allergy.

[Allergy to house dust mites]. / Alergia na roztocze kurzu domowego.

There are presented the etiology and pathogenesis of house dust and house dust mite allergy. The house dust mite ecology, physicochemic and immunochemic properties of house dust mite allergens, methods of quantitating exposure to these allergens; the relationship between level of exposure, sensitization and disease, likewise avoidense measures for mite allergens in houses are described.

Rapid host nation medical deployment.

Rapid development of land-based units in Operation Desert Shield/Storm presented critical needs for medical support. Integration of small Navy mobile medical teams in Bahrain and a larger United States Army Hospital unit in Riyadh, Saudi Arabia, at host nation hospitals presented an innovative method of providing this support. The success of these ventures in convenience and quality of care establishes the host nation interaction with military medical professionals as a workable, satisfying, and important adjunct to standard military medical care.

Preparations for war in a Saudi Arabian host nation hospital.

This paper describes how the King Fahad National Guard Hospital in Riyadh, The Kingdom of Saudi Arabia, integrated United States Army (USA) medical units and prepared the hospital to receive war casualties during Operation Desert Storm. In particular, preparation of the hospital, the staff, and military systems are reviewed. The report will also discuss operations at the hospital during Operation Desert Storm and the major lessons learned. Comment is provided by the host nation hospital regarding the impact of the experience with the USA medical units and their personnel.

Grateful Med: gateway to world-wide literature.

Grateful Med is a computer software package developed by the National Library of Medicine which provides access to MEDLINE and other medical databases. The program is available for both IBM and Macintosh computers, is inexpensive, easy to install and has excellent documentation. Health professionals in all areas find Grateful Med to be a user-friendly, cost-effective way to search current, world-wide medical literature.

Building a team on a medical floor.

The article describes a case in which dysfunctional teamwork was threatening patient care on medical units. Various team-building techniques were used by trained facilitators. Survey results showed that the interventions resulted in improved communication, morale, and working relationships.

[Preliminary studies of the occurrence of Ixodes ricinus (Acari: Ixodida: Ixodidae) in the areas of the Cracow-Czestochowa highland at various stages of human industrial activities]. / Wstepne badania nad wystepowaniem Ixodes ricinus (Acari: Ixodida: Ixodidae) na obszarach Jury Krakowsko-Czestochowskiej w róznym stopniu zmienionych antropopresja.

In the years 1987-88 the density of the population of I. ricinus on the territory of Kraków-Czestochowa Highland including the Ojców National Park was studied. The method of collection of ticks from 100 m2 fields was applied. On the spite of similar ecological conditions there was marked variation in the population density of I. ricinus. It decreased from East to West, where territories are under the strong pressure of the Upper Silesia and Olkusz industry.

Preliminary study on the concentration and species composition of bacteria, fungi and mites in samples of house dust from Silesia (Poland).

Twenty-one samples of house dust collected from dwellings situated in Upper Silesia (Poland) were subjected to bacteriological, mycological and acarological examination. Moreover, in two samples the concentration of bacterial endotoxin was estimated by the use of Limulus test. The mean concentration of bacteria in the examined samples was 2831.9 thousands cfu (colony forming units) per gram, that of fungi - 28.4 thousands cfu per gram, and that of mites - 51.5 specimens per gram. No significant correlation could be found between the numbers of these three components of house dust. Two examined samples of house dust contained high amounts of bacterial endotoxin which are comparable to the concentration of endotoxin in agricultural dusts, and could be of immunopathogenic significance. In the bacterial flora of the examined house dust samples, staphylococci prevailed in 45.9% of all isolates, streptococci (23.2%), corynebacteria (13.9%) and spore-forming bacilli (12.2%). Among fungi, the most numerous were strains of the genus Penicillium (39.4%), yeasts (29.5%) and strains of the genus Aspergillus (8.4%). Both bacteria and fungi comprise species that are known for their allergenic properties. The mite fauna of the examined samples was dominated by Dermatophagoides farinae (62.7% of all specimens) and Dermatophagoides pteronyssinus (30.4%); both species are known as important allergens of house dust. The results hitherto obtained indicate the potential significance of all the investigated components (bacteria, fungi and mites) in causing allergy to house dust.

Paracooperioides peleae gen. et sp. n. (Nematoda: Trichostrongylidae) from the vaal ribbok, Pelea capreolus (Forster, 1790).

A new genus and species of trichostrongylid nematode, Paracooperioides peleae, was collected from the small intestines of vaal ribbok, Pelea capreolus (Forster, 1790), from the bontebok National Park, Swellendam, Cape Province. These nematodes are small and slender with a small cephalic inflation. The cuticle bears numerous transverse striations which are more pronounced anteriorly. The dorsal ray is long and is similar to that of Gazellostrongylus Yeh, 1956, and Cooperioides hepaticae Ortlepp, 1938, but differs in that it bifurcates in its distal quarter, Each branch divides again, giving rise to a thinner, outer branch and a thicker inner branch. The latter recurves upon itself to form a small, elongated knob. The spicules of paracooperioides peleae resemble those of C. hepaticae but can be differentiated from them in that they bear small lateral barbs on their tips. Ten longitudinal ridges, supported by sclerotized rods, are present at the middle of the body. In transverse section, Paracooperiodes peleae is intermediate between Cooperioides Daubney, 1933 and Paracooperia travassos, 1935.